Jaramillo-Magaña JJ

Idioma: Español
Referencias bibliográficas: 27
Paginas: 235-242
Archivo PDF: 536.72 Kb.

FRAGMENTO

Incidencia

La ruptura aneurismática es la causa más común de hemorragia subaracnoidea (HSA) y se asocia con una alta morbimortalidad. Sólo dos de cada tres pacientes con HSA por ruptura de aneurisma, alcanzan atención médica. En los EUA, se estima en 10 a 28 casos anuales por cada 100,000 habitantes. De éstos, la mitad muere antes de recibir atención médica (Cuadro I). De la mitad que alcanza a recibir atención médica, el 25 al 50% morirán o tendrán graves secuelas neurológicas. Sólo un tercio de este grupo de pacientes, tendrá una recuperación física adecuada. 4–5% de los pacientes con grados 1–3 morirán en espera de cirugía, 25% de los pacientes llegarán al hospital dentro de las primeras 24 horas de la hemorragia subaracnoidea (45% en grados 1–2) y 75% de los pacientes llegarán al hospital después de 72 horas de la hemorragia subaracnoidea (85% en grados 3–5). Los aneurismas no rotos tienen un riesgo de sangrado del 1–2% por año, mientras que los aneurismas que han sangrado tienen un riesgo de resangrado de 50% al cabo de los primeros 6 meses, de la hemorragia inicial. Después de este período el riesgo de hemorragia repetida disminuye a 3% por año. La distribución etaria de HSA alcanza un pico entre los 40–60 años. La frecuencia en cuanto a sexo es 3:2 con relación mujer/hombre.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Kotapka MJ, Flamm ES. Cerebral aneurysms: surgical considerations. En: Anesthesia and Neurosurgery. James E. Cottrell, David S. Smith (eds). 3rd Ed. Mosby - Year Book, Inc, 1994. Chapter 17, pp:364-375.

2. Kassell NF, Torner JC, Haley C, et al. The international cooperative study on the timing of aneurysm surgery. I: overall management results. J Neurosurg 1990;73:18-32.

3. Rinkel GJE, Wijdicks EFM, Ramos LMP, Van Guijn J. Outcome in perimesencephalic (nonaneurysmal) subarachnoid hemorrhage: a follow up study in 37 patients. Neurology 1990;40:1130-2.

4. Jackobsen M, Enevoldsen E, Bjerre P. Cerebral blood flow and metabolism following subarachnoid hemorrhage: cerebral oxygen uptake and global blood flow during the acute period in patients with subarachnoid hemorrhage. Acta Neurol Scand 1980;82:174-83.

5. Volby B, Enevoldsen EM, Jensen FT. Cerebrovascular reactivity in patients with ruptured intracranial aneurysms. J Neurosurg 1985;62:59-63.

6. Asano T, Sano K. Pathogenic role of no-reflow phenomenon in experimental subarachnoid hemorrhage in dogs. J Neurosurg 1977;46:454-66.

7. Guy J, McGrath BJ, Borel CO, Friedman AH, Warner DS. Perioperative management of aneurysmal subarachnoid hemorrhage: Part 1. Operative management. Anesth Analg 1995;81:1060-72.

8. Boterell EH, Lougheed WM, Scott JW, Vanderwater SL. Hypothermia and interruption of the carotid or carotid and vertebral circulation in the surgical management in intracranial aneurysms. J Neurosurg 1956:13:1-43.

9. Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 1968;28:14-20.

10. WFNS: World Federation of Neurological Surgeons. Anonymous. Report of World Federation of Neurological Surgeons Committee on a universal subarachnoid hemorrhage grading scale. J Neurosurg 1988;68:985-6.

11. Eng C, Lam AM. Cerebral aneurysms: Anesthetic considerations. En: Anesthesia and Neurosurgery. James E. Cottrell, David S. Smith (eds). 3rd Ed. Mosby - Year Book, Inc, 1994. Chapter 18;pp376-405.

12. Awad IA, Carter LP, Spetzler RF, et al. Clinical vasospams after subarachnoid hemorrhage: response to hypervolemic hemodilution and arterial hypertension. Stroke 1987:18:367-69.

13. Doshi R, Neil-Dwyer G. Hypothalamic and miocardial lesions after subarachnoid hemorrhage. J Neurol Neurosurg Psychiatry 1977;40:821.

14. Davies KR, Gelb AW. Manninen PH, et al. Cardiac function in aneurysmal subarachnoid hemorrhage. A study of electrocardiographic and echocardiography abnormalities. Br J Anaesth 1991;67:58-61.

15. Pollick C, Cujec B, Parker S. Left ventricular wall motion abnormalities in subarachnoid hemorrhage: an echocardiography study. J Anesth Crit Care 1988;12:600.

16. Kassell NF, Torner JC, Jane JA, et al. The international cooperative study on the timing of aneurysm surgery. II. Surgical results. J Neurosurg 1990;73:37-47.

17. Haley EC Jr, Kassell NF, Torner JC, Participants. The international cooperative study on the timing of aneurysm surgery: the North American experience. Stroke 1992;23:205-14.

18. Ravussin P, Templehoff R, Modica PA, Bayer-Berger MM. Propofol, thiopental and isoflurane for neurosurgical anesthesia: comparison of hemodynamics, CSF, pressure, and recovery. J Neurosurg Anesthesiol 1991;3:85-95.

19. Ravussin P, Detribulet N, Guanott SL. Total intravenous anesthesia with propofol for burst suppression in cerebral aneurysm surgery - preliminary report of 42 patients. Neurosurgery 1993;32:236-40.

20. Frizzell RT, Meyer YJ, Borchers J, et al. The effect of etomidate on cerebral metabolism and blood flow in a canine model for hypoperfusion. J Neurosurg 1991;74:263-9.

21. Calvin CE, Lam AM, Byrd S, Newell DW. The diagnosis and management of a perianesthetic cerebral aneurysmal rupture aided with transcranial Doppler ultrasonography. Anesthesiology 1993;78:191-4.

22. Giannotta SL, Oppenheimer JH, Levy ML, Zelman V. Management of intraoperative rupture of aneurysms without hypotension. Neurosurgery 1991;28:531-5.

23. Spetzler RF, Hadley MN. Protection against cerebral ischemia: the role of barbiturates. Cerebrovasc Brain Metab Rev 1989;1:212-29.

24. Newfield P, Hamid RKA, Lam AM. Intracranial aneurysm and A-V malformations. Anesthetic management. En: Albin MS (ed). Textbook of neuroanesthesia with neurosurgical and neuroscience perspectives. McGraw-Hill Co, New York, St. Louis, San Francisco. 1997. Chapter 26, pp:859-900.

25. Deibert E, Barzilai B, C Braverman A, Edwards DF, Aiyagari V, Dacey R, Diringer M. Clinical significance of elevated troponin I levels in patients with nontraumatic subarachnoid hemorrhage. J Neurosurg 2003;98:741-6.

26. Grathwohl KW, Black IH, Spinella PC, Sweeney J, Robalino J, Helminiak J, Grimes J, Gullick R, Wade CE. Total Intravenous Anesthesia Including Ketamine versus Volatile Gas Anesthesia for Combat-related Operative Traumatic Brain Injury. Anesthesiology 2008;109:44-53.

27. Bebawy JF, Gupta DK, Bendok BR, Hemmer LB, Zeeni C, Avram MJ, Batjer HH, Koht A. Adenosine-Induced Flow Arrest to Facilitate Intracranial Aneurysm Clip Ligation: Dose-Response Data and Safety Profile. Anesth Analg 2010;110:1406-1411.